DEPARTMENT OF HUMAN SERVICES
DIVISION OF FAMILY DEVELOPMENT
CONTRACT ADMINISTRATION
CONTRACT AWARD or RENEWAL PACKAGE
WFNJ – Family Violence Option (FVO) PROGRAM
Contract Renewal Package
Required Documents and Forms
Annex A:
Program Summary
Contract Summary Sheet
Authorized Signatures
Service Delivery Information
Program Narrative
Renewal Documents:
Index of Required Contract Documents
Contract Checklist
Document Verification Sheet (DVS)
Executive Order 129
Certification of Suspension and Debarment
List of Contracts/Grants
Contract Forms (List of Required Documents Available on DFD Website)
Annex B Helpful Hints
Federal Award Information
Instructions
Program Summary
Enter the information on the site where services for this program are provided.
Contract Summary Sheet
Enter Agency Name, Address, Telephone and Contract No., Federal Identification No., Contract effective dates (as noted in the DFD contract award letter) and contract ceiling (per Annex B).
Enter CEO and Agency notice information. All data must be completed.
Authorized Signatories
Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board Resolution).
IMPORTANT - This is the address where the signed contract and all relevant legal correspondence will be mailed – so please ensure this is the accurate address.
Service Delivery Information
Service will be provided as follows for each day of the week, enter the hours the agency will provide contracted services. Please indicate if there is a difference among any of the contracted services in the program specific narrative.
Emergency Provisions Describe any special arrangements which have been made to handle emergencies, e.g. voice mail instructions, special telephone numbers etc.
Service will not be provided on the following occasions List the occasions and dates when service will not be provided, e.g. December 25-Christmas, July 4-Independence Day, etc.
Program Narrative
*Please see specific instructions attached to this section
ANNEX A - Program Summary
Program Name:Site Address:
City, State, and Zip
Site Phone Number: / - -
Program Director/Coordinator
Telephone #: / - -
Fax: / - -
E-Mail:
STATE OF NEW JERSEY - DIVISION OF FAMILY DEVELOPMENT
ANNEX A – CONTRACT SUMMARY SHEET
Provider Agency / Contract #Mailing Address / Federal ID #
Telephone Number / - -
Provider Agency Fiscal Year End
Contract Effective Date / to / Contract Ceiling / $
Organization Type / County
Municipal (i.e. School)
Private, Non-Profit
Private, For-Profit / % / Indicate % of profit charged towards contract
Faith-Based
Hospital-Based
Chief Executive Officer
Title
Mailing Address
Telephone Number / - -
Fax Number / - -
E-Mail Address
All routine notices relevant to the administration of the program should be sent to:
Name & Title
Mailing Address
Telephone Number / - -
Fax Number / - -
E-Mail Address
Do you currently receive payment by Automatic Deposit (ACH) for this contract?
Yes No
Division of Family Development
Annex A
Authorized Signatures
List names and positions of persons authorized to sign the following and number of persons required to sign each transaction.
Name/Address / Position / # of Signatures RequiredContract / 1 / 1
2
3
Quarterly and Final Financial Reports / 1 / 1
2
3
Contract
Budget Modification / 1 / 1
2
3
Checks / 1
2
3
Other Contracts and Agreements / 1
2
3
Note 1 - Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board Resolution). This is the address where the signed contract and all relevant legal correspondence will be mailed. This should be the individual who signs the SLD (page 23). This may not be the same individual as noted in the Annex A summary sheet. In the event of emergency notification, please include e-mail and fax number.
Contract SignatoryTitle
Mailing Address
Telephone Number / - -
Fax Number / - -
E-Mail Address
Contract #
Division of Family Development
Annex A
Service Delivery Information
Program Name:Site Address:
City, State, and Zip
Site Phone Number: / - -
Program Director/Coordinator
Telephone #: / - -
Fax: / - -
E-Mail:
Service will be provided as follows (designate time):
From / ToSunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Services will not be provided on the following occasions:
Date (s) / OccasionDivision of Family Development
ANNEX A
PROGRAM OPERATIONS NARRATIVE
Introduction and Instructions:
Following are the contract components to be administered for the program. The Provider Agency shall describe the components as they are administered internally. The Annex A, Program Description information should match the details included in the Annex B - Budget.
The Provider Agency must provide information in the Annex A narrative describing how each service component of this contact will be administered including internal processes and controls for each program/service component. Answer all questions by providing information that is quantifiable and qualifiedly measurable to the extent feasible.
Please note that the contract term may be Calendar Year (starts 1/1), State Fiscal Year (SFY) (starts 7/1) or Federal Fiscal Year (FFY) (starts 10/1).
Key Statutory and Regulation Requirements under this contract
a. Determine who is eligible to receive Federal and State financial assistance;
b. Have internal controls and performance measures to determine whether the rules are accurately applied;
c. Adherence to applicable Federal rules and State program compliance requirements; and
d. Assurance of appropriate use of allowable government funds to carry out the goals and objectives of the program.
The Provider Agency assures that it will comply with the following statutory requirements and ensure Federal and State funds are applied to:
Eligible Clients – By statue – only families that meet program eligibility criteria
The agency agrees that a minimum it will provide the following required minimum staffing:
Personnel Requirements
The Agency Director or program designee must attend and participate in DFD-sponsored in-person meetings and trainings, or conference calls as directed by the Program Staff.
Fiscal Standards and Accountability
Recipients and sub-recipients of Federal and State funds are responsible for the proper use of such fund. Simply, this means that the funds are used for the intended purpose with compliance with all Federal, State and contract regulations. All parties are responsible for the transparency and accountability for the funds and are subject to administrative, contractual and legal sanctions for the misuse and/or improper use of these funds. Provider Agencies are considered sub-grantee/recipients under this contract and are subject to Federal laws, regulations and provisions of this contract as set forth in this document; and must ensure adherence to all applicable regulations.
The agency must meet all contract expectations as described in the RFP as well as those detailed in this contract. Failure to meet any performance standard and contract expectations can be grounds for revision of the contract whereby current funding is reduced, contract is suspended or terminated and can affect future consideration for funding.
In addition to the core areas of program delivery, Provider Agencies must maintain administrative and fiscal accountability, meet reporting requirements, and ensure program integrity to meet all program compliance and performance standards. As recipients of government funds, all agencies must adhere to all federal and state laws and regulations as stated above.
Reporting Requirements
The agency is required to submit program and fiscal reports within the required timeframes. At a minimum, the following reports are required:
I. Fiscal Reports
A. Report of Expenditures
Fiscal reporting is required on a quarterly basis combining subcontracted and direct agency expenditures. Actual expenditures must be reported using the Annex B form on a cumulative basis by the 20th day of the following month after the close of each calendar quarter.
The Final Report of Expenditures is due 120 days after the contract period ends.
The expenditure reports must contain an original signature of the CEO and fiscal officer designated by the agency for this program.
An initial advance payment will be issued when the contract is fully executed. Future quarterly reimbursements will occur subsequent to DFD’s receipt and review of the expenditure report for the previous quarter and as long as all other contract deliverables are met.
All reports are to be sent to:
DFD, Office of Contract Administration
P.O. Box 716
Trenton, New Jersey 08625-0716
Attention: Contract Fiscal Unit
II. Program Reports
Program reports are to be submitted to the Program Office as specified in the Annex A.
III. Payment Terms
The initial advance payment representing 25% of the contract ceiling will be issued when the contract is approved and signed. Subsequent quarterly advance payments are issued upon receipt and review of the quarterly report of expenditures (ROE) and, assuming all other contract obligations are current and there are no violations of any other contract provisions. Adjustments to a quarterly payment may be made for a variety of reasons, including provider agency spending patterns, DFD fiscal review issues, audit matters that come to our attention, or as needed to meet program delivery and DFD Budget/ Fiscal issues.
DIVISION OF FAMILY DEVELOPMENT
WFNJ - Family Violence Option Initiative (FVO)
ANNEX A
PROGRAM GOALS AND DESCRIPTION
The Department of Human Services’ Division of Family Development (DFD) recognizes that domestic violence (DV) is a well-documented public health issue that can include physical, sexual, economic, emotional, social and/or psychological abuse. The purpose of the Work First New Jersey (WFNJ) Family Violence Option (FVO) Initiative is to safely move Temporary Assistance for Needy Families (TANF) and General Assistance (GA) clients who self-disclose domestic violence to self-sufficiency.
The FVO grants temporary “good cause” waivers of WFNJ program requirements to TANF/GA recipients. The program waivers must meet the definition of a federally recognizable good cause waiver based on 45 CFR §260.50-59; N.J.S.A 44:10-59d; N.J.A.C. 10:90-20).
The WFNJ FVO is administered by the County and Municipal Welfare Agencies (C/MWA) and audited, monitored and evaluated by DFD. The C/MWA:
1. Provides information on the FVO;
2. Screens for domestic violence while maintaining confidentiality;
3. Refers such individuals to counseling and supportive services; and
4. Grants temporary waivers of WFNJ’s program requirements when compliance with program requirements would make it difficult to escape domestic violence or places individuals at further risk.
Family Violence Option (FVO) Waivers must:
1. Identify the specific program requirements being waived;
2. Be granted based on risk, as determined by a risk assessment/safety plan, performed by a person trained in domestic violence, and re-determined at least every six months; and
3. Be accompanied by a service plan that is designed to lead to work to the extent that engaging in employment does not endanger the individual.
FVO individuals must be given every opportunity to safely comply with WFNJ program requirements and work participation. The C/MWA shall make all reasonable efforts to provide child care and transportation to make it possible for individuals to complete the risk assessment/safety plan and participate in counseling, intervention services and other support services which promote safety and self-sufficiency.
The C/MWA and DV provider agencies must work together to ensure risk assessments, safety plans and service plans are completed. However, it is the role of the C/MWA to grant or rescind program waivers and it is the role of the DV agencies to substantiate risk of domestic violence.
The FVO provides flexibility in service planning by appropriately granting certain temporary program waivers when program requirements place individuals at risk of domestic violence, but does not exclude individuals from the safe participation in services or activities that lead to self-sufficiency and employment. These services or activities may include the following:
1. Domestic violence counseling, court/legal interventions and supportive services;
2. Substance abuse and behavioral health assessments and treatment which are available at no cost to TANF/GA individuals through the Division of Family Development (DFD) Substance Abuse/Behavioral Health Initiatives;
3. The DFD TANF Initiative for Parents (TIP) for pregnant TANF/GA women and TANF women with a child 12-months or younger;
4. DFD approved employment readiness activities which may include, but are not limited to: educational or vocational, job training, community or alternative work experiences and job search.
CONFIDENTIALITY
State and Federal Confidentiality Statues and Business Associate Agreements
Confidentiality for FVO clients must be vigorously maintained. Family violence concerns shall be handled in a confidential and private manner by all C/MWA staff. In addition, the DV service provider agency is bound by the "victim-counselor privilege” under New Jersey law (N.J.S.A. 2A:84A-22.13), which means the specifics of the violence will not be shared with anyone outside the provider agency, including the WFNJ agency staff, without a signed consent to release information. Any information released with a signed consent is limited to that information which is necessary for the C/MWA to grant waivers appropriately, case mange the FVO case, coordinate services and ensure safety.
The Victim Counselor Privilege 2A:84A-22.13.
Results, declarations:
1. The Legislature finds and declares that:
a. The emotional and psychological injuries that are inflicted on victims of violence are often more serious than the physical injuries suffered;
b. Counseling is often a successful treatment to ease the real and profound psychological trauma experienced by these victims and their families;
c. In the counseling process, victims of violence openly discuss their emotional reactions to the crime. These reactions are often highly intertwined with their personal histories and psychological profile;
d. Counseling of violence and victims is most successful when the victims are assured their thoughts and feelings will remain confidential and will not be disclosed without their permission; and
e. Confidentiality should be accorded all victims of violence who require counseling whether or not they are able to afford the services of private psychiatrists or psychologists.
2. Therefore, it is the public policy of this State to extend a testimonial privilege encompassing the contents of communications with a victim counselor and to render immune from discovery or legal process the records of these communications maintained by the counselor.
3. Programs receiving Violence Against Women Act (VAWA) or Family Violence Prevention and Services Act (FVPSA) funding, are also bound by the Federal regulations on the treatment of confidential Information at Section 40002(b)(2) of the Violence Against Women Act of 1994 (42 U.S.C.13925(b)(2)).